Pediatric emergency department patient care guidelines
July 1, 2002 2 minutes read
Pediatric Emergency Department Patient Care Guidelines
CONDITION: Laceration Repair (Dermabond)
PRIORITY: Category 3
SUPERVISION: Attending/Fellow
Tissue adhesives (cyanoacrylates) have been used to close wounds for more than a decade in Europe. Several studies done in the United States and Canada have shown that closure of small, low-tension lacerations with tissue adhesives is a faster and less painful method of laceration repair that has cosmetic results similar to that of suturing. Dermabond recently has been approved by the Food and Drug Administration (FDA) and will be used in this institution.
Indications:
Clean:
1. lacerations less than 4 cm in length and 0.5 cm in width, not requiring deep-layer closure;
2. lacerations less than 12-hours old;
3. lacerations that would require size 5-0 or 6-0 sutures;
4. lacerations with minimal to no tension on the edges;
5. lacerations with no abrasions along the edges.
Contraindications:
1. infected lacerations;
2. animal and human bites;
3. lacerations with devitalized tissue;
4. lacerations needing debridement;
5. heavily soiled wounds;
6. lacerations on mucous surfaces or crossing mucocutaneous surfaces;
7. lacerations on wound sites subjected to prolonged moisture and friction;
8. lacerations in high-tension areas such as the chin and over joints;
9. stellate lacerations from crush injuries;
10. laceration close to the eye (e.g., on eyelid);
11. active bleeding;
12. allergy to cyanoacrylates;
13. young children who are unable to hold reasonably still during application;
14. young children who are likely to pick at the adhesive.
Procedure:
Use of Dermabond is restricted to the Pediatric Emergency Medicine (PEM) faculty and fellows. Residents will be permitted to use Dermabond only under the direct and continuous supervision of the PEM attending or fellow.
1. Laceration must be thoroughly cleaned and hemostasis achieved with dry gauze and pressure.
2. Wound edges must be approximated and everted and a thin film of tissue adhesive applied longitudinally with a light brushing motion of the applicator over easily approximated wound edges.
3. Three to five thin layers should be applied onto a dry wound allowing time for polymerization (30 seconds) between applications. The adhesive should never be placed inside the wound.
4. Full polymerization takes about one minute, and manual approximation and slight eversion of the wound edges must be maintained during that time.
5. If the laceration is in the proximity of the orbit, the eye should be covered with gauze.
6. Error at the site of union can be corrected by removing the adhesive in the first few seconds after application by dabbing with dry swab or wiping with dry gauze.
7. The wound may be covered with a Band-Aid and should be kept dry for at least five days. The adhesive peels off in approximately one week. Do not put ointment over the adhesive, as it will alter the adhesive properties.
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